Estimation of Changes in Psychological Characteristics (Anxiety and Depression Levels) and Quality of Life in Head and Neck Cancer Patients

Cancer is a disease in which a group of cells display uncontrolled growth, invasion and angiogenesis. It is the most common cause of mortality and morbidity all over the world. It is not only a physical disease but is also a disease that has predominant psychosocial effects. Anxiety and depression are the two major psychological problems seen in cancer patients. They are associated with stress due to diagnosis of cancer, physical illness and post treatment side effects. Apart from these, psychological distress in cancer patients may also be associated with certain other factors like age, sex, socioeconomic status, marital status, presence of dependent children in the family and habits. Undiagnosed and untreated psychological problems in cancer patients can affect their health, treatment routine and quality of life. Thus identifying and treating psychological problems is very essential. The present study was conducted to evaluate the changes in anxiety and depression levels in head and neck cancer patients before treatment, after treatment and during post discharge period, to evaluate the influence of factors like age, sex, socioeconomic status, dependent children, marital status and habits on the distress levels of cancer patients and to evaluate the relationship between anxiety and depression levels before treatment, after treatment and during post discharge period with the quality of life. AIMS AND OBJECTIVES: To evaluate the changes in anxiety and depression levels in head and neck cancer patients before treatment, after treatment and during post discharge period. To evaluate and compare the influence of factors like age, sex, marital status, socioeconomic status, dependent children and habits on the anxiety and depression levels in head and neck cancer patients. To evaluate the relationship between anxiety and depression levels before treatment, after treatment and during post discharge period with the quality of life. METHODOLOGY: The study consisted of 50 patients. Out of the 50 subjects, 36 were males, 14 were females,9 were between the age group 31 to 40 years, 16 were between 41 to 50 years, 14 were between 51 to 60 years, 9 were between 61 to 70 years, 2 were between 71 to 80 years, 24 were single, 26 had their life partner, 33 had stable socioeconomic status, 17 had unstable socioeconomic status, 22 had dependent children, 28 had independent children, 37 had deteriorating habits, and 13 had no deteriorating habits. HADS - Hospital Anxiety and Depression Scale and FACT-G and FACT-H&N (Functional Assessment of Cancer Treatment-General and Head & Neck), self-assessment questionnaires were given to all the 50 patients before treatment, immediately after treatment and during the post discharge period (1 month after treatment) to evaluate the changes in psychological levels and to determine the quality of life in these patients before treatment, after treatment and during post discharge period. The patients were then segregated according to factors like age, sex, marital status, socioeconomic status, dependent children in family and deteriorating habits. The influence of these factors on the anxiety and depression levels were compared and evaluated. Then by statistical analysis the changes in anxiety and depression levels in head and neck cancer patients before treatment, after treatment and during post discharge period; the levels of anxiety and depression levels in association with factors like age, sex, marital status, socioeconomic status, dependent children in family and habits and relationship between anxiety and depression levels before treatment, after treatment and during post discharge period with the quality of life were calculated, compared and tabulated. RESULTS: The results showed that there was a significant raise in anxiety levels before treatment (p=.000) and depression levels after treatment (p=.000) and a significant decline in both anxiety and depression levels during post discharge period. A significant raise in the anxiety and depression levels after treatment and during post discharge period (p value = .000, .050 for anxiety and p = .041, .000 for depression) was noted among younger patients (30 to40years). There was a significant raise in anxiety levels before treatment (p=.000), after treatment (p=.000) and during post discharge period (p=.001) and depression levels before treatment (p=.000) and after treatment (p=.012) among female patients. A significant raise in anxiety levels before treatment (p=.000) and during post discharge period (p=.023) and depression levels after treatment (p=.026) and during post discharge period (p=.005) was noted among single patients. A significant raise in anxiety levels (P=.060) and depression levels (P=.042) after treatment among patients with unstable socioeconomic status were noted. There was a significant raise in depression levels after treatment (p=.005) and during post discharge period (p=.002) and anxiety levels before treatment (p=.005) among patients who have dependent children. There were not much difference in anxiety and depression levels among patients with and without deteriorating habits. When depression and anxiety levels were high, quality of life (physical well-being and emotional well-being) scored high and (functional well-being and social well-being) scored less in head and neck cancer patients before treatment, after treatment and during post discharge period with statistically significant values thus indicating that quality of life was better before treatment, poor immediately after treatment and improved during post discharge period among head and neck cancer patients. CONCLUSION: Thus anxiety levels were more before treatment, depression levels were more after treatment and both anxiety and depression levels were less during post discharge period in head and neck cancer patients. Correlation was obtained between the levels of anxiety and depression and factors like age, sex, marital status, socioeconomic status and presence of dependent children in family. But however there was no correlation between the anxiety and depression levels and deteriorating habits. Quality of life (physical well-being, emotional well-being, functional well-being, social well-being and additional concerns) was better before treatment; very poor immediately after treatment as anxiety and depression levels were very high and improved during the post discharge period as the distress levels reduced to a great extent